Yang Xiao, Leesar Massoud A, Ahmed Hinan, Lendel Vasili, Rodriguez Gerardo, Mutlu Deniz, Cawich Ian, Prasad Anand, Oglesby Meagan, Marmagkiolis Kostas, Phillips Nathanael E, Jouke Dijkstra, Michalek Joel, Liu Qianqian, Milner Thomas, McElroy Austin, Hoyt Taylor, Feldman Marc D, Cilingiroglu Mehmet
University of Texas Health Science Center San Antonio, San Antonio, TX, United States.
University of Alabama Birmingham, Birmingham, AL, United States.
Cardiovasc Revasc Med. 2018 Oct;19(7 Pt A):778-784. doi: 10.1016/j.carrev.2018.02.013. Epub 2018 Feb 23.
To compare OCT identified white thrombus decline, neointimal hyperplasia and clinical outcomes of patients treated with ticagrelor plus aspirin with those patients treated with clopidogrel plus aspirin after peripheral interventions.
Ticagrelor is a potent platelet inhibitor. In patients with coronary artery disease, ticagrelor and aspirin demonstrated reduced rates of stent thrombosis, compared to aspirin and clopidogrel. The clinical importance of potent antiplatelet inhibition after peripheral endovascular interventions is unknown.
We enrolled 18 patients with superficial femoral artery disease and the presence of OCT-detected clot post-stent placement. Patients were randomized to 75 mg clopidogrel once daily for 1 month vs. 90 mg ticagrelor twice daily for 6 months, both in addition to 81 mg aspirin for 6 months. Clot volumes, ankle-brachial index (ABI), 6-minute walk test, and Rutherford classification were measured at baseline and 6-month follow-up. Neointimal hyperplasia and neovascularization were calculated at 6-month follow-up.
N = 11 patients were enrolled in the clopidogrel group and N = 7 in the ticagrelor group. There was a significantly greater decrease in white thrombus in the ticagrelor group (median volume/stent length (0.067 vs 0.014 mm/mm, p = 0.05)). No differences were found in % neointima (0.412 vs 0.536 mm/mm, p = 0.44) and neovascularization (28 vs 44, p = 0.16). ABI and Rutherford classification were improved significantly after 6 months in the clopidogrel group, with no difference between groups at 6 months in ABI or Rutherford.
In symptomatic patients with PAD, ticagrelor showed significant improvement relative to clopidogrel with respect to white thrombus burden decline.
比较替格瑞洛联合阿司匹林与氯吡格雷联合阿司匹林治疗外周血管介入术后患者的光学相干断层扫描（OCT）显示的白色血栓减少情况、新生内膜增生及临床结局。
替格瑞洛是一种强效血小板抑制剂。在冠状动脉疾病患者中，与阿司匹林和氯吡格雷相比，替格瑞洛和阿司匹林可降低支架血栓形成率。外周血管内介入术后强效抗血小板抑制的临床重要性尚不清楚。
我们纳入了18例股浅动脉疾病且支架置入后存在OCT检测到血栓的患者。患者被随机分为两组，一组每天服用75mg氯吡格雷，共1个月；另一组每天服用90mg替格瑞洛，共6个月，两组均联合服用81mg阿司匹林，共6个月。在基线和6个月随访时测量血栓体积、踝臂指数（ABI）、6分钟步行试验及卢瑟福分级。在6个月随访时计算新生内膜增生和新生血管形成情况。
氯吡格雷组纳入11例患者，替格瑞洛组纳入7例患者。替格瑞洛组白色血栓减少明显更多（中位体积/支架长度分别为0.067 vs 0.014mm/mm，p = 0.05）。新生内膜百分比（0.412 vs 0.536mm/mm，p = 0.44）和新生血管形成情况（28 vs 44，p = 0.16）两组间无差异。氯吡格雷组6个月后ABI和卢瑟福分级显著改善，6个月时两组间ABI或卢瑟福分级无差异。
在有症状的外周动脉疾病患者中，与氯吡格雷相比，替格瑞洛在白色血栓负荷降低方面有显著改善。
